PBMs launch counterattack following Trump administration’s plan to end drug rebates

Pharmacy benefit managers are hitting back against critics who blame them for rising drug prices, as the system they use to negotiate rebates on drugs hangs in the balance. 

The Pharmaceutical Care Management Association this week launched a campaign called #OnYourRxSide, which aims to education consumers about the role PBMs play in their health benefits and the role they play in bringing down costs at the pharmacy counter. 

“PBMs have an established and successful track record of implementing consumer-friendly, market-based tools, such as negotiating with drug manufacturers, to reduce costs for consumers,” JC Scott, president and CEO of the association, said in a statement

“This campaign is designed to break through the noise in the drug pricing debate and clearly demonstrate how PBMs are the advocates for consumers in the fight to lower prescription drug costs. 

RELATED: Winners and losers under bold Trump plan to slash drug rebate deals 

PBMs and insurers are on the defensive following the long-awaited release of the Trump administration’s plan to overhaul the rebate system. The Department of Health and Human Services issued a proposed rule in which it plans to eliminate the antikickback safe harbors for drug rebates and instead offer safe harbors to discounts passed directly to consumers. 

The first pieces of PCMA’s campaign include a series of new ads that aim to reorient the discussion around rebates to how they pay off for the consumer; for example, one shareable image says that PBMs will be able to negotiate drug prices down by $654 billion over the next decade. 

Express Scripts, the country’s largest PBM and now a subsidiary of Cigna, released its annual Drug Trend Report Wednesday morning, which also puts a positive spotlight on the work of PBMs.

Express Scripts said that drug spending across its employer plans increased by 0.4%, the lowest trend in 25 years, in 2018. Drug spending in its Medicare plans decreased by 0.3%, according to the report. Members paid an average of $11.60 for a 30-day supply of medication, up just 6 cents from 2017. 

RELATED: Express Scripts hits back at criticisms of PBMs, says it ‘would do just fine’ without drug price rebates 

Glen Stettin, M.D., chief innovation officer at Express Scripts, told FierceHealthcare that while the company wasn’t shocked by the findings, the results “are going to be a surprise to the nation” amid the drug price debate. 

“The vast majority of the rebate dollars we collect go back to our clients—it's our client’s money,” he said. “We would never be able to produce these results without getting that money back for our clients.” 

Spending on traditional medications decreased by 5.8% in 2018, while spending on specialty drugs went up by 9.4%, though it was a lower increase than in 2017, according to the report. Stettin said there’s room for Express Scripts and other PBMs to innovate how they work with these drugs and in providing biosimilar alternatives. 

Another area to improve, he said: how benefits are administered to patients with high cost-sharing.  

"We do a good job, on average, of keeping costs in check,” Stettin said, “and at the same time there’s still more to do, particularly to do for people in high-deductible plans or who are underinsured to protect them from what are, essentially, the list prices of prescription drugs.”